Provider Demographics
NPI:1376641449
Name:CARDIOLOGY ASSOCIATES MEDICAL GROUP
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:805-653-0101
Mailing Address - Street 1:168 N BRENT ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2817
Mailing Address - Country:US
Mailing Address - Phone:805-653-0101
Mailing Address - Fax:805-643-6285
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:SUITE 503
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2817
Practice Address - Country:US
Practice Address - Phone:805-653-0101
Practice Address - Fax:805-643-6285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0001490Medicaid
CAGR0001490Medicaid
CAW15207AMedicare PIN